While NHS organisations often get caught up in documenting the benefits and justifying the expense of clinical supervision, the most important thing to keep sight of are the benefits to the people directly involved the process

We must accept that clinical supervision is an absolute expectation of the clinical governance agenda and that it is actually a very positive and rewarding thing to do in our professional lives.

So what is the problem with implementing clinical supervision?Is it that:

  • people do not have time for it in their working life;

  • there is no place to go and receive supervision that is protected and private;

  • there is a problem with training people to be supervisors as training often focuses on theory rather than the competence and confidence practitioners need to deliver supervision;

  • there is still critical debate and disagreement over what clinical supervision actually is;

  • it is being held up as a quality assurance tool or a way to aid retention and recruitment of staff rather than an intrinsically worthwhile process;

  • or is it because it is constantly confused with management supervision and the boundaries of each structure are not clear?

I believe some of the resistance to clinical supervision comes from the perception that it is about managing staff or policing, and from the fact that it lacks understanding and trust among nurses.

Over the past 10 years as a trainer, I have met too few people who were actually engaging in effective clinical supervision in work time. Like any other continuing professional development achievements, clinical supervision must be endorsed, valued and facilitated by senior management structures in the organisation in which you work.

Successful supervision

The secret to providing successful clinical supervision is the ability to listen to someone else's story; to resist the temptation of advising on, owning or solving their problems; and to engage in a meaningful way to help the other person reflect on what is happening, what they are feeling and what they are doing. Only then will they be freed to make their own decisions.

Clinical supervision offers a venue where people can talk about difficulties with relationships, concern or disagreement over clinical decisions and emotional investment in professional relationships.

When I facilitate training courses, I am often asked whether clinical supervision is on a par with counselling or other therapeutic relationships. My answer is simple. Supervisors draw from the knowledge and skill base of counselling and therapeutic working but are not counsellors or therapists.

Developing competence

Is clinical supervision too formal? Although it is a very serious activity, it is really just about giving staff members a trusted, reliable facilitator to enable confidential reflection on practice.Clinical supervision is about talking, not keeping records and documentation. It exists for the supervisee, not the management or the organisation. It is about reflection, not detection. It is about developing conscious competence.

There is a lot of debate on documentation and, it seems, a lot of uncertainty about what happens if you do not document. Do not be anxious as a supervisor about the need to keep previous agendas. What matters is the here and now, reflecting on the issues and problems surrounding your supervision at that time. Trust your supervisee to bring to each session the things that are of key importance to them.

The issue of collating evidence regarding the success and the effects of clinical supervision is a bit trickier. I understand and support the need for organisations to be able to justify such a huge expenditure, but how do you evaluate or provide evidence of the effectiveness of a confidential and trusting relationship that exists for the individual?

Some organisations believe it is their right to receive copies of supervision documentation agendas to justify its existence. Other managers are not concerned with specific evidence but are willing to defer the evaluation of clinical supervision outcomes as a longer-term measurement concerned with staff recruitment, retention and satisfaction.

The most important thing is that the benefit of clinical supervision is experienced and felt by the people directly involved in it.

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